2018-01-23 13:14:55 UTC

Image Challenge: Cullen's Sign

Jan. 22, 2018

What caused a 56-year-old man with a previous history of cirrhosis to present with a large volume of ascites and periumbilical ecchymosis?

Gastroenterology Clinical Image Challenge: A 56-year-old man with a previous history of cirrhosis secondary to chronic hepatitis C infection was admitted with increased abdominal volume and dyspnea. Physical examination revealed a large volume of ascites and periumbilical ecchymosis (Figure). He was hemodynamically stable and laboratory included hemoglobin of 9.7 g/dL, platelet count of 142,000/mmand an International Normalized Ratio of 1.27. He had no abdominal pain and serum amylase was normal. A diagnostic and therapeutic paracentesis revealed an hemorrhagic ascites, with a serum ascites albumin gradient of 1.8, no evidence of peritonitis and negative oncotic cytology. Dyspnea improved after paracentesis.

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.

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